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Association between the triglyceride-glucose index and poor prognosis in patients undergoing endovascular therapy across glucose metabolic status groups

This multicenter retrospective study demonstrates that a higher triglyceride-glucose (TyG) index is independently associated with poor 90-day prognosis in acute ischemic stroke patients undergoing endovascular therapy, a relationship that remains significant across normal glucose regulation and diabetes groups despite the highest poor outcome rates occurring in diabetic patients.

Original authors: wei deng, Zhengqiao Bao, Jun Han, Peiyang Zhou, Guangxian Nan, Yanli Sun

Published 2026-07-01

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CC BY 4.0

Original authors: wei deng, Zhengqiao Bao, Jun Han, Peiyang Zhou, Guangxian Nan, Yanli Sun

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine your body's blood vessels as a complex network of highways. When a major traffic jam (a stroke) happens because a large road is blocked, doctors use a special "tow truck" procedure called Endovascular Therapy (EVT) to clear the blockage and restore flow. But even after the road is cleared, some drivers (patients) still end up with a rough ride, while others recover smoothly.

This study asks: Is there a simple "dashboard warning light" we can check right when the patient arrives that predicts who will have a rough recovery?

The researchers found that a specific number called the TyG Index acts like that warning light.

What is the TyG Index?

Think of the TyG Index as a metabolic "stress score." It's calculated using two very common blood tests:

Triglycerides: The fat in your blood (like oil in a car engine).
Glucose: The sugar in your blood (like fuel).

When you have high levels of both, your body is under metabolic stress. The TyG Index combines these two numbers into a single score. A higher score means your body is struggling more with how it handles sugar and fat.

The Big Discovery

The researchers looked at nearly 800 patients who had this "tow truck" procedure for a major stroke. They found a clear pattern:

The Higher the Score, The Rougher the Ride: Patients with a high TyG Index were significantly more likely to have a poor outcome 90 days later (meaning they were still disabled or unable to care for themselves).
It's a Straight Line: The relationship wasn't wobbly or confusing; it was a straight line. As the TyG score went up, the risk of a bad outcome went up steadily.
It Works Even with Other Factors: This link held true even after the researchers accounted for other things that usually affect recovery, like age, blood pressure, or how severe the stroke was initially. The TyG Index was an independent predictor.

Does It Matter if You Have Diabetes?

The researchers wanted to know if this "warning light" worked differently for different types of drivers. They split the patients into three groups based on their sugar metabolism:

Normal Glucose (NGR): People with normal sugar levels.
Prediabetes (Pre-DM): People on the edge.
Diabetes (DM): People with diagnosed diabetes.

The Results:

The TyG Index was a strong predictor for people with Normal Glucose and those with Diabetes.
Interestingly, it didn't show a strong link for the Prediabetes group in this specific study.
Crucially: The study found that having diabetes didn't change how the TyG Index worked as a predictor. The "warning light" was still relevant, regardless of which group you were in. However, it's worth noting that the group with the highest number of poor outcomes was the Diabetes group overall.

Why Does This Happen? (The "Why" Behind the "What")

The paper suggests a few reasons why a high TyG score leads to a worse recovery, using biological metaphors:

The Clogged Pipes: High sugar and fat levels can make blood vessels stiff and less able to relax, like old, rusty pipes that can't handle pressure.
The Toxic Spill: High sugar can cause inflammation and oxidative stress, which is like spilling corrosive chemicals on the brain tissue that was already damaged by the stroke.
The Clotting Machine: High metabolic stress might make the blood more likely to form tiny clots or make the brain's defense systems weaker, leading to more damage even after the main blockage is cleared.

The Bottom Line

The study concludes that the TyG Index is a simple, easy-to-calculate number that doctors can use to get a better idea of who might struggle after a stroke procedure.

It adds value: Adding this number to the standard medical check-up slightly improved the ability to predict who would have a poor outcome.
It's not a magic bullet: The study was retrospective (looking back at old records), so it can't prove that the TyG Index causes the bad outcome, only that they are linked.
Who needs to know? This applies specifically to patients with large vessel strokes undergoing EVT.

In short, if you imagine the body as a car, the TyG Index is a simple gauge that tells you how much "gunk" (sugar and fat) is in the system. The more gunk there is, the harder it is for the car to recover after a major crash, even if the mechanics (doctors) do a perfect job fixing the immediate damage.

Technical Summary: Association between the Triglyceride-Glucose Index and Poor Prognosis in AIS Patients Undergoing EVT

Problem Statement
Acute ischemic stroke (AIS), particularly those involving large vessel occlusion (LVO), remains a leading cause of disability worldwide. While endovascular therapy (EVT) is the standard of care for eligible LVO patients, a significant proportion of patients still experience poor functional outcomes despite successful reperfusion. Identifying simple, early metabolic markers that can aid in risk stratification and post-procedural management is critical. Insulin resistance (IR) is a known contributor to cerebrovascular disease, and the triglyceride-glucose (TyG) index has emerged as a surrogate marker for IR. However, evidence regarding the prognostic value of the TyG index in AIS patients undergoing EVT, specifically across different glucose metabolic status groups (normal glucose regulation, prediabetes, and diabetes), remains limited and unclear.

Methodology
This study employed a multicenter retrospective cohort design involving 789 AIS patients who underwent EVT at six stroke centers in China between September 2018 and January 2024.

Population: Patients were aged ≥18, had LVO, and received EVT. Exclusion criteria included a pre-stroke modified Rankin Scale (mRS) score ≥2, missing fasting glucose/HbA1c data, or loss to 90-day follow-up.
Exposure: The TyG index was calculated as $Ln[TG (mg/dL) \times FPG (mg/dL) / 2]$ . Patients were categorized into tertiles (T1: ≤8.51, T2: 8.51–9.20, T3: >9.20).
Stratification: Glucose metabolic status was classified based on American Diabetes Association criteria into Normal Glucose Regulation (NGR), Prediabetes Mellitus (Pre-DM), and Diabetes Mellitus (DM).
Outcome: The primary outcome was poor prognosis, defined as an mRS score ≥3 at 90 days.
Statistical Analysis: Binary logistic regression models were used to evaluate associations, adjusting for age, sex, smoking, atrial fibrillation, hypertension, baseline NIHSS, ASPECTS, IVT, onset-to-puncture time, TOAST etiology, and occlusion location. Restricted cubic spline analysis assessed dose-response relationships. Predictive value was evaluated using C-statistics, Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI).

Key Results

Overall Association: In the final cohort of 789 patients, 55.5% (438) experienced poor prognosis. The TyG index was independently associated with poor prognosis as a continuous variable (Adjusted OR = 1.65; 95% CI 1.32–2.07; P < 0.001). When analyzed by tertiles, the T3 group had a significantly higher risk of poor prognosis compared to T1 (Adjusted OR = 2.04; 95% CI 1.36–3.05; P = 0.001).
Stratified Analysis: Stratification by glucose metabolic status revealed that the association between the TyG index and poor prognosis was significant in the NGR group (Adjusted OR = 8.37; P = 0.011) and the DM group (Adjusted OR = 1.46; P = 0.021), but not in the Pre-DM group (P = 0.164). However, formal interaction testing indicated that glucose metabolic status did not significantly modify the association (P for interaction = 0.123).
Dose-Response: Restricted cubic spline analysis demonstrated a positive linear association between the TyG index and poor prognosis in the overall cohort, with no evidence of non-linearity.
Predictive Value: Adding the TyG index to a basic clinical model modestly improved prognostic discrimination (C-statistic increased from 0.747 to 0.761; P = 0.029) and risk reclassification (NRI = 0.238; P = 0.002). The improvement was most pronounced in the NGR subgroup.
Subgroup Consistency: The association remained robust across most prespecified subgroups (age, sex, hypertension, etc.) and in sensitivity analyses excluding patients without successful reperfusion.

Significance and Claims
The authors conclude that the TyG index is an independent predictor of 90-day poor prognosis in AIS patients undergoing EVT. The study highlights that this association follows a positive linear trend and is not significantly modified by glucose metabolic status, although patients with DM exhibited the highest absolute proportion of poor outcomes. The authors posit that the TyG index, being a simple and readily available marker, may serve as a useful tool for refining post-EVT risk stratification.

The paper acknowledges several limitations, including its retrospective nature, the relatively small sample size of the NGR subgroup, the use of TyG as a surrogate rather than a direct measure of insulin resistance, and the exclusive inclusion of Chinese patients, which may limit generalizability. Consequently, the authors call for further validation in larger, prospective, and more diverse cohorts before definitive clinical applications can be established.